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Tattoo removal is becoming better. We're still not great at it. It takes multiple treatments, and they have to be separated usually four to six weeks. The darker colors are generally easier to treat, have better results, and the lighter colors are harder to treat. The closer you are to the head, the easier it is to treat, the farther away, the harder it is.

I don't think that tattoo removal has to be painful. There are a couple of methods you can do to improve that. We put topical numbing cream on all patients, and that helps, but you can inject it and you can be completely numb. You could also use colt [SP], and improve it. You shouldn't have blistering afterwards. A lot of people think that that's part of the routine. That actually is an undesirable result, potentially causing scarring, hypopigmentation, hyperpigmentation. That's a myth, too, but you shouldn't have to do a lot of care afterwards.

There are a couple of new techniques for tattoo removal. There's something called the R20 protocol. Like I previously said, tattoo removals, you’ll need 8, 10, 12 treatments sometimes, but what the R20 protocol is, is doing four treatments in one day separated by 20 minutes of cooling down period. The reason why you can't do four treatments traditionally right away is because underneath the skin are these gas bubbles, and that inhibits the laser from working properly, but if you wait 20 minutes, the gas bubbles dissipate and you can treat again. Those four treatments aren't equal to four treatments given over every six weeks, but it is more than one treatment. So I say approximately two, two and a half treatments it equals to.

The newest technology is putting a little chemical on the skin that is completely harmless, has no side effects, and it allows those bubbles to dissipate almost immediately. Instead of being in the office for an hour, hour and a half, you can go rapid fire, and you can go four treatments successively. Not everyone's a candidate; darker skin individuals probably, you want to treat a little more carefully, and the other thing is that you probably don't want to treat all the wavelengths like that. But the 1064 Q-switched laser is great for that, and I routinely treat people four times with the 1064 Q-switched.

Tattoo Removal: Success Rates, Misconceptions, and Treatment Options

While Dr. Steven F. Weiner discusses the developing practice of tattoo removal including new treatments.